Infectious Mononucleosis Complicated With Idiopathic Thrombocytopenic Purpura: A Case Report and Literature Review

Abstract Background: Epstein-Barr virus (EBV) is the cause of infectious mononucleosis (IM), a self-limited lymphoproliferative disorder among patients. EBV usually infects B-lymphocytes rather than T-lymphocytes. The clinicopathologic features of the idiopathic thrombocytopenic purpura (ITP) patients complicated with EBV-positive IM have been rarely described.Case presentation: We describe a case of a 19-year-old man complained with epistaxis and thrombocytopenia for one year, who was admitted to hospital for high grade fever after catching a cold. A lot of petechiae were found on the skin of both lower limbs and both hands during physical examination. Multiple enlarged lymph nodes could be touched in both sides of the neck. Ultrasound examination showed abnormal lymph nodes enlargement on both sides of the neck and supraclavicular area, and a strong echo mass was found in the liver. Serological tests for EBV revealed high level of IgM and IgG antibodies against viral capsid antigen (VCA), virus DNA quantitative<1000UI/mL. CD8-positive cytotoxic T cells accounted for up to 92.94% by flow cytometry. T cells were positive for CD38, CD57 and HLA-DR marker. Bone marrow cytology showed that the proportion of lymphocytes had increased considerably, and the rate of abnormal lymphocyte was as high as 29.5%. EBV virus encoded RNA was demonstrated in lymph node biopsy by in-situ hybridization (ISH) analysis. Immunohistochemically, there were more CD8-positive cells than CD4-positive cells in lymph node biopsy. The expression of CD7 was missing. CD99 was diffuse positive. The MIB-1/ki-67 labeling index was about 70%. EBER in situ hybridization revealed positive signals located in the nucleus. The patient was diagnosed as Infectious mononucleosis complicated with idiopathic thrombocytopenic purpura. The patient was hospitalized and discharged after recovery.Conclusions: ITP patients complicated with EBV-positive IM have been rarely reported in the literature. Comprehensive understanding of its clinicopathological features will help diagnose of this disease.

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Detection of Epstein-Barr virus messenger RNA in Reed-Sternberg cells of Hodgkin's disease by in situ hybridization with biotinylated probes on specially processed modified acetone methyl benzoate xylene (ModAMeX) sections [see comments]

Blood ◽

10.1182/blood.v77.8.1781.1781 ◽

1991 ◽

Vol 77 (8) ◽

pp. 1781-1786 ◽

Cited By ~ 78

Author(s):

P Brousset ◽

S Chittal ◽

D Schlaifer ◽

J Icart ◽

C Payen ◽

...

Keyword(s):

In Situ Hybridization ◽

Lymph Node ◽

Messenger Rna ◽

Epstein Barr Virus ◽

Lymph Node Biopsy ◽

Mixed Cellularity ◽

Barr Virus ◽

Node Biopsy ◽

Epstein Barr

Abstract Microscopic intracellular detection of Epstein-Barr virus (EBV) messenger RNA in Reed-Sternberg cells of Hodgkin's disease (HD) was possible by in situ hybridization, in tissue sections prepared by a method termed modified acetone methyl benzoate xylene (ModAMeX). The ModAMeX method was initially developed for simultaneous optimal preservation of leucocyte differentiation antigens and morphology. Two biotinylated DNA probes, corresponding to the same BamHI-W (internal repeat) of the EBV genome were used. EBV mRNA was detected in neoplastic cells in 16 of 54 (30%) lymph node biopsy specimens from usual subtypes of HD (lymphocyte predominance, 0/5; nodular sclerosis, 4/22; mixed cellularity, 12/26; unclassified, 0/1). EBV mRNA was also detected in the lymph node biopsy of 1 additional human immunodeficiency virus (HIV)-related case of HD (mixed cellularity) and in 2 of 4 cases of B-cell lymphomas occurring in patients with acquired immunodeficiency syndrome (AIDS). In other non-Hodgkin's lymphomas, EBV mRNA was detected in only 1 of 41 cases. Cases of HD positive for EBV mRNA were immunostained by CD30 and CD15 antibodies. The hybridization signals were exclusively restricted to Reed-Sternberg cells and variants. When analyzed retrospectively, no statistically significant correlation emerged between hybridization findings, EBV serology, or disease outcome over the 3 years of the availability of ModAMeX technique. The findings support the contention of a direct role of EBV in the pathogenesis of HD, at least in some cases.

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Detection of Epstein-Barr virus messenger RNA in Reed-Sternberg cells of Hodgkin's disease by in situ hybridization with biotinylated probes on specially processed modified acetone methyl benzoate xylene (ModAMeX) sections [see comments]

Blood ◽

10.1182/blood.v77.8.1781.bloodjournal7781781 ◽

1991 ◽

Vol 77 (8) ◽

pp. 1781-1786 ◽

Cited By ~ 2

Author(s):

P Brousset ◽

S Chittal ◽

D Schlaifer ◽

J Icart ◽

C Payen ◽

...

Keyword(s):

In Situ Hybridization ◽

Lymph Node ◽

Messenger Rna ◽

Epstein Barr Virus ◽

Lymph Node Biopsy ◽

Mixed Cellularity ◽

Barr Virus ◽

Node Biopsy ◽

Epstein Barr

Microscopic intracellular detection of Epstein-Barr virus (EBV) messenger RNA in Reed-Sternberg cells of Hodgkin's disease (HD) was possible by in situ hybridization, in tissue sections prepared by a method termed modified acetone methyl benzoate xylene (ModAMeX). The ModAMeX method was initially developed for simultaneous optimal preservation of leucocyte differentiation antigens and morphology. Two biotinylated DNA probes, corresponding to the same BamHI-W (internal repeat) of the EBV genome were used. EBV mRNA was detected in neoplastic cells in 16 of 54 (30%) lymph node biopsy specimens from usual subtypes of HD (lymphocyte predominance, 0/5; nodular sclerosis, 4/22; mixed cellularity, 12/26; unclassified, 0/1). EBV mRNA was also detected in the lymph node biopsy of 1 additional human immunodeficiency virus (HIV)-related case of HD (mixed cellularity) and in 2 of 4 cases of B-cell lymphomas occurring in patients with acquired immunodeficiency syndrome (AIDS). In other non-Hodgkin's lymphomas, EBV mRNA was detected in only 1 of 41 cases. Cases of HD positive for EBV mRNA were immunostained by CD30 and CD15 antibodies. The hybridization signals were exclusively restricted to Reed-Sternberg cells and variants. When analyzed retrospectively, no statistically significant correlation emerged between hybridization findings, EBV serology, or disease outcome over the 3 years of the availability of ModAMeX technique. The findings support the contention of a direct role of EBV in the pathogenesis of HD, at least in some cases.

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Cytologic Features of Lipogranulomatous Reaction in an Axillary Sentinel Lymph Node

Acta Cytologica ◽

10.1159/000513982 ◽

2021 ◽

pp. 1-4

Author(s):

Jose Antonio Jimenez-Heffernan ◽

Mariel Valdivia-Mazeyra ◽

Patricia Muñoz-Hernández ◽

Consuelo López-Elzaurdia

Keyword(s):

Lymph Node ◽

Sentinel Lymph Node ◽

Sentinel Lymph Node Biopsy ◽

Lymph Nodes ◽

Breast Biopsy ◽

Lymph Node Biopsy ◽

Sentinel Lymph Nodes ◽

Fat Necrosis ◽

Histologic Analysis ◽

Node Biopsy

Introduction: Multinucleated giant cells (MGC) are a rare finding when evaluating axillary sentinel lymph nodes. Some are described as foreign body-type MGC accompanied by foamy macrophages. They have been rarely reported in nodes from patients in which a previous breast biopsy was performed. The tissue damage induced by biopsy results in secondary changes including fat necrosis and hemorrhage that can migrate to axillary nodes. In this report, we illustrate a lipogranulomatous reaction in cytologic samples obtained during a sentinel lymph node examination of a woman previously biopsied because of breast carcinoma. We have found no previous cytologic descriptions and consider it an interesting finding that should be known to avoid diagnostic misinterpretations. Case: A 51-year-old woman underwent mastectomy of the right breast with a sentinel lymph node biopsy at our medical center. One month before, a control mammography revealed suspicious microcalcifications and a vacuum-assisted breast biopsy resulted in a diagnosis of high-grade intraductal carcinoma with comedonecrosis. Surgery with a sentinel lymph node biopsy was performed. The sentinel node was processed as an intraoperative consultation. Frozen sections and air-dried Diff-Quik stained samples were obtained. They showed abundant lymphocytes with MGC and tumoral cells. MGC showed ample cytoplasm with evident vacuoles of variable size. Occasional hemosiderin-laden macrophages were also present. The complete histologic analysis and immunohistochemical studies revealed no malignant cells. Histologic analysis showed, in subcapsular location, occasional MGC phagocyting lipid droplets. Hemosiderin-laden macrophages were a common finding. Conclusion: Lipogranulomas may appear at axillary sentinel lymph nodes because of fat necrosis induced by previous breast biopsy. The most important consideration is not confounding MGC with epithelial cell clusters. This can occur with not well-processed samples, especially if unmounted.

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Sentinel lymph node biopsy in patients with ductal carcinoma in situ

Cancer ◽

10.1002/cncr.10641 ◽

2002 ◽

Vol 95 (1) ◽

pp. 15-20 ◽

Cited By ~ 46

Author(s):

Kelly M. McMasters ◽

Celia Chao ◽

Sandra L. Wong ◽

Robert C. G. Martin ◽

Michael J. Edwards

Keyword(s):

Lymph Node ◽

Sentinel Lymph Node ◽

Sentinel Lymph Node Biopsy ◽

Ductal Carcinoma In Situ ◽

Carcinoma In Situ ◽

Ductal Carcinoma ◽

Lymph Node Biopsy ◽

Node Biopsy

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Is Sentinel Lymph Node Biopsy Indicated at Completion Mastectomy for Ductal Carcinoma In Situ?

Annals of Surgical Oncology ◽

10.1245/s10434-016-5145-z ◽

2016 ◽

Vol 23 (7) ◽

pp. 2229-2234 ◽

Cited By ~ 7

Author(s):

Melissa Pilewskie ◽

Maria Karsten ◽

Julia Radosa ◽

Anne Eaton ◽

Tari A. King

Keyword(s):

Lymph Node ◽

Sentinel Lymph Node ◽

Sentinel Lymph Node Biopsy ◽

Ductal Carcinoma In Situ ◽

Carcinoma In Situ ◽

Ductal Carcinoma ◽

Lymph Node Biopsy ◽

Node Biopsy

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The Predictors of Tumor Invasion for Patients with an Initial Diagnosis of Ductal Carcinoma in situ and the Indications for Performing Sentinel Lymph Node Biopsy

Journal of the Korean Surgical Society ◽

10.4174/jkss.2010.79.6.436 ◽

2010 ◽

Vol 79 (6) ◽

pp. 436 ◽

Cited By ~ 2

Author(s):

Hee Jae Lee ◽

Seung Ook Hwang ◽

Jin Hyang Jung ◽

Ho Yong Park ◽

Ji Young Park

Keyword(s):

Lymph Node ◽

Sentinel Lymph Node ◽

Sentinel Lymph Node Biopsy ◽

Ductal Carcinoma In Situ ◽

Tumor Invasion ◽

Carcinoma In Situ ◽

Ductal Carcinoma ◽

Lymph Node Biopsy ◽

Node Biopsy

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Axillary Sentinel Lymph Node Biopsy in Patients With Pure Ductal Carcinoma In Situ of the Breast

Archives of Surgery ◽

10.1001/archsurg.138.3.309 ◽

2003 ◽

Vol 138 (3) ◽

pp. 309 ◽

Cited By ~ 119

Author(s):

Mattia Intra

Keyword(s):

Lymph Node ◽

Sentinel Lymph Node ◽

Sentinel Lymph Node Biopsy ◽

Ductal Carcinoma In Situ ◽

Carcinoma In Situ ◽

Ductal Carcinoma ◽

Lymph Node Biopsy ◽

Node Biopsy

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Carbon nanoparticle-guided intraoperative lymph node biopsy predicts the status of lymph nodes posterior to right recurrent laryngeal nerve in cN0 papillary thyroid carcinoma

Gland Surgery ◽

10.21037/gs-20-920 ◽

2021 ◽

Vol 10 (5) ◽

pp. 1554-1563

Author(s):

Yuwei Ling ◽

Lina Zhang ◽

Kaifu Li ◽

Ye Zhao ◽

Jing Zhao ◽

...

Keyword(s):

Lymph Node ◽

Papillary Thyroid Carcinoma ◽

Thyroid Carcinoma ◽

Lymph Nodes ◽

Lymph Node Biopsy ◽

Laryngeal Nerve ◽

Papillary Thyroid ◽

Carbon Nanoparticle ◽

Node Biopsy ◽

The Status

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An AN OBSERVATIONAL STUDY OF SLN MAPPING IN PATIENTS OF LOCALLY ADVANCED BREAST CANCER FOLLOWING NCT

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v4i2.899 ◽

2020 ◽

Vol 4 (2) ◽

Author(s):

Ankur Garg ◽

Udbhav Kathpalia ◽

Shweta Bansal ◽

Manoj Andley ◽

Sudipta Saha

Keyword(s):

Lymph Node ◽

Sentinel Lymph Node ◽

Adjuvant Chemotherapy ◽

Lymph Nodes ◽

Locally Advanced ◽

Lymph Node Biopsy ◽

Axillary Lymph Nodes ◽

Axillary Lymph ◽

Node Biopsy ◽

Neo Adjuvant Chemotherapy

Background : Locally advanced breast carcinoma (LABC) includes a wide range of clinical scenarios- advanced primary tumors (T4), advanced nodal disease and inflammatory carcinomas(1). Traditionally, treatment of LABC included a combination of Chemotherapy, Radiation and Surgery(2). However, there has been a shift to Neoadjuvant Chemotherapy in recent times.(3) Histological status and the number of axillary lymph nodes with metastasis is one of the most important prognostic factors and most powerful predictor of recurrence and survival in patients of breast carcinoma and remains so, even after neo-adjuvant chemotherapy. (3) Information derived from the sentinel lymph node is considered valuable, with less discomfort to the patient when compared with axillary dissection.(4) However, its role in detecting nodal metastasis after neo-adjuvant chemotherapy in LABC is still debatable and definitive studies to evaluate its role are still evolving. (5) Materials and Methods: Patients of LABC were evaluated using ultrasonography (USG) of axilla. Neo-adjuvant chemotherapy (NACT) was administered and patients were reassessed by USG of axilla. Thirty patients with node negative axillary status were subjected to Sentinel lymph node mapping using isosulfan blue followed by Modified Radical Mastectomy and Axillary Lymph Node Dissection. Histopathological evaluation of stained and unstained lymph nodes done and the data, thus obtained, was statistically analysed. Results: Sentinel lymph node biopsy performed using Isosulfan Blue dye alone, after neo-adjuvant chemotherapy predicts the status of axillary lymph nodes with low accuracy. Conclusions: Further studies would be required to establish the role of sentinel lymph node biopsy in patients with LABC after NACT.

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